Provider Demographics
NPI:1710014105
Name:THOMAS A. CIULLA, MD,PC
Entity Type:Organization
Organization Name:THOMAS A. CIULLA, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-817-1822
Mailing Address - Street 1:200 W 103RD ST
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1007
Mailing Address - Country:US
Mailing Address - Phone:317-817-1822
Mailing Address - Fax:317-817-1898
Practice Address - Street 1:200 W 103RD ST
Practice Address - Street 2:SUITE 1050
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1007
Practice Address - Country:US
Practice Address - Phone:317-817-1822
Practice Address - Fax:317-817-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN189520Medicare ID - Type UnspecifiedID